Professor Kathleen Lynch:

I thank the committee for inviting me to speak. I will draw on my extensive research on care, in particular, care within families, care of children and on a book I have just recently written on care and capitalism. I will make five observation on the universal need for care; that care takes different forms; the commercialisation of care; the need for a national care planning unit; and the question of measuring care. We learned something important during the Covid-19 pandemic, which is that most people cannot enjoy life without care. Most people realise now that we are relational rather than autonomous human beings. It may seem very academic but it is hugely important because vulnerability, dependency and interdependency are endemic to the human condition and nurturing is what makes us emotionally healthy and happy human beings. Given the primacy of love and care for mental and emotional health especially, Ireland needs to develop a political and cultural appreciation of care as a political principle. In fact, there can be no political or social justice without imbuing public policymaking with an ethic of care.

Care takes different forms and I want to make a few observations on this. It is always spoken about as if it is a singular entity but it is very important to distinguish when talking about children especially and older people who are very dependent, that love is separate from care and love is not substitutable. People who are very old, no matter how vulnerable they are, need love as well as professional care. Love is the relationships which we have with others, which are intimate and which we cannot transfer to someone else. You cannot pay someone to go visit your mother in hospital and say that is yourself. That is an important issue because sometimes we think we can regulate people to love and care for people professionally. Unfortunately, we can ensure their safety but we cannot force people to be kind, gentle or loving to somebody else. That is an important issue in terms of how we speak about care, especially care of children but also care of older people, because care takes time and care is always in competition with our political time, our economic time and our market time. Professional care has a voluntary and personal dimension to it and in much of the talk about care, this is often forgotten. Someone cannot be forced by regulation to give empathy and understanding. It is not simply supplied on contract. While educating people helps them to be more caring, it does not necessarily guarantee it. If we have hurried care, if someone is constantly under pressure and if there are time pressures, people will simply will not have time to give meaningful care to another human being and this is a significant issue care of older people. Defining personal care, as it often is, as bodily care, also shows a profound lack of respect for the feelings and needs of people as emotional human beings.

I want to refer briefly about commercialisation. Ireland has experienced a huge change in the past 25 to 30 years in how it provides care, especially for older people but even for children. For-profit care is now the biggest player in residential care for children who are going into State care. More than half of the homes for children in residential care are for-profit. This has been brought up lately by Tusla. I am making these comments as observations. Most providers of day care for children are private operators and they are businesses, albeit small ones, though some are big businesses and I have referred to them in the submission. In the case of nursing homes, 70% of nursing home beds are now owned by for-profit companies. This is an exact reversal of what it was in the 1980s when 60% of nursing home beds were provided in the public sector, 25% in the voluntary and community sector and 15% in non-profit private sector. This is a major change in policymaking. There is a graph showing this in the submission I have made to the committee. The same is true in home care. The proportion of public expenditure allocated to private-for-profit rose from 5% of all expenditure in 2006 to 40% in 2019, while HSE delivered home care declined from 85% to 50% in 2019. Table 2 shows this. Why does this all matter? When for-profit begins to dominate residential care, home care and childcare, it sets the terms and conditions for other care providers in the field. The corporatisation of care changes the terms on which care is given. There is a lot of international research on this. Reducing pay, casualising labour, short-staffing, charging hidden fees, social costs, and often, in some cases, only taking wealthier clients.

The financialisaton of care is also part of what happens with commercialisation. Although we are having no discussion on this, I refer the committee to two reports published recently by Public Services International entitled The Crisis in Long-Term Care - Effects of Private Provision; and Care Givers and Takers - How finance extracts wealth from the care sector.

Why does all this matter? Does it matter who provides care? Yes, it does. Commercialisation alters the terms of the debate about care, defining it as a "product", often ignoring the ethical and relational dilemmas endemic to caring. I will make a number of quick observations about care. Care logic is different to market logic. It is about meeting human needs and not efficiencies per se. I am not saying they do not have to be efficient but it is about meeting needs. Care cannot be measured in quantifiable outcomes because it is an experience rather than a product. Care needs are variable; they vary with the person. Also the temporal logic of care - how we use time and how we think about time - is very different. Care cannot be done in measurable time because it is driven by needs, as anyone who has been a family carer knows, rather than by specific timeframes. It is not infinitely condensable. You cannot give fast care like you give fast food. If you do, you have the same consequences except in the case of care what you have is people getting pre-packaged units of supervision. They do not get care.

Good caring is about relationships and they cannot be supplied by regulation or order alone. Relationships have to be developed and therefore staff need to be continuous and supported and they need to stay over time. The rationality of care contradicts bureaucratic logic. That is why so many people do not want to go into institutional care because they know in a bureaucracy, regardless of how well managed it is, there is always a problem with bureaucratic rules and regulations, which are inevitable in large institutions. That limits the flexibility available to meet the nurturing needs of very vulnerable people, especially people who are non-verbal.

The very concept of "care package", which is ubiquitously used in Ireland, implies that care is a commodity like a package of groceries. This contradicts the very meaning of care. It changes the definition of a person from a citizen to a customer. A citizen has rights and responsibilities. They are not a market product. I will give the committee examples of how many of our Departments have started using market language at the end.

My next point is about democratic changes. I cannot understand why we do not have a national care planning unit. We know, for example, the demographics in the case of older people. If we can model for the pandemic and make predictions surrounding people, surely we can make predictions of the needs and costs of caring for people according to their own wishes as they get older. The same goes for childcare.

Finally, I want to make a remark about measuring care. The census, since time immemorial, has only measured the care of adults, as care in Ireland. As far as I remember, 25 years ago we made a submission saying that question No. 21 should be changed. A huge number of people, mostly women, are also carers of children. Some are carers of adults and children. I ask that question No. 21 be changed in any future census so that care is measured.

I thank the committee for its attention and I am very willing to make observations on other matters as well, but that is all I have to say for now.